Form 67.5-D Form of consent of a parent or guardian to petition for an order freeing a child for adoption under section 18 of the Adoption (Scotland) Act 1978 IN THE COURT OF SESSION in the PETITION of [A.B.] (designation and address) for An order freeing the child [E.F.] for adoption under section 18 of the Adoption (Scotland) Act 1978
I,
, of (address) being a parent [or guardian] of the child [E.F.], hereby state-
(1) That I consent to the petition of [A.B.], an adoption agency, for an order freeing the child for adoption. (2) That I understand that the petitioner cannot apply to the court for an order freeing the child for adoption without the consent of a parent or guardian, unless the petitioner is applying for dispensation of the agreement of each parent or guardian of the child and the child is in the care of the petitioner. (Signed by parent or guardian) This consent was signed by (Signed) (Designation) (Address) before me at on the day of